Bioethics Forum Essay

Immigrant Health in the Public Charge Era: 15 Essential Articles

Updated June 19, 2020

The public charge rule went into effect nationwide recently, formalizing the “public charge era” that began when the draft rule was leaked three years ago. The rule jeopardizes eligibility for legal permanent residency (green card) if applicants are deemed public charges based on even short-term use of federally funded programs, such as health insurance, housing subsidies, or food stamps. Anticipation of the rule has had chilling effects on the behavior of immigrants, who have avoided or withdrawn from health-related programs for which they are eligible. These chilling effects also have consequences for citizen children in mixed-status families.

The new reality of public charge requires new ways to think about and respond to the health-related needs of legally authorized immigrants, as well as the longstanding challenges of providing medically appropriate care to undocumented immigrants who are excluded from these programs and who are targeted by immigration enforcement.

The Hastings Center’s Undocumented Patients project, founded in 2011, maintains a public database of key literature and other resources on health care access for undocumented immigrants and other immigrant populations in the U.S. What follows is a selected bibliography designed to support learning and progress on immigrant health in a complex policy environment. It includes recent research findings, analysis, and commentaries on health care access for low-income authorized immigrants affected by the public charge rule. It also includes selections of literature on the health consequences of immigration enforcement targeting undocumented immigrants and asylum seekers; patterns of immigration to major population centers; and the importance of municipal governments, regional health systems, and other local organizations in meeting the health care needs of immigrant communities.

Public charge: health consequences

Artiga, Samantha, Rachel Garfield, and Anthony Damico. 2019. “Estimated Impacts of Final Public Charge Inadmissibility Rule on Immigrants and Medicaid Coverage.” Kaiser Family Foundation. https://www.kff.org/disparities-policy/issue-brief/estimated-impacts-of-final-public-charge-inadmissibility-rule-on-immigrants-and-medicaid-coverage/.

Bernstein, Hamutal, Dulce Gonzalez, Michael Karpman, Sarah McTarnaghan, and Stephen Zuckerman. 2019. “Five Ways the ‘Public Charge’ Rule Is Affecting Immigrants in America.” Urban Institute. https://www.urban.org/urban-wire/five-ways-public-charge-rule-affecting-immigrants-america.

Gelatt, Julia, and Mark Greenburg. 2019. “Health Insurance Test for Green-Card Applicants Could Sharply Cut Future U.S. Legal Immigration.” Migration Policy Institute. https://www.migrationpolicy.org/news/health-insurance-test-green-card-applicants-could-sharply-cut-future-us-legal-immigration.

Haley, Jennifer, Genevieve Kenney, Hamutal Bernstein, and Dulce Gonzalez. 2020. “One in Five Adults in Immigrant Families with Children Reported Chilling Effects on Public Benefit Receipt in 2019.” Urban Institute. https://www.urban.org/research/publication/one-five-adults-immigrant-families-children-reported-chilling-effects-public-benefit-receipt-2019.

Katz, Mitchell H., and Dave A. Chokshi. 2018. “The ‘Public Charge’ Proposal and Public Health.” JAMA 320 (20): 2075. https://doi.org/10.1001/jama.2018.16391.

Page, Kathleen R., and Sarah Polk. 2017. “Chilling Effect? Post-Election Health Care Use by Undocumented and Mixed-Status Families.” New England Journal of Medicine 376 (12): e20. https://doi.org/10.1056/nejmp1700829.

Parmet, Wendy E. 2020. “Supreme Court Allows Public Charge Rule to Take Effect While Appeals Continue.” Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/hblog20200131.845894/full/.

Zallman, Leah, and Karen Finnegan. 2018. “Changing Public Charge Immigration Rules: The Potential Impact on Children Who Need Care.” California Health Care Foundation. https://www.chcf.org/publication/changing-public-charge-immigration-rules/.

Zallman, Leah, Karen E. Finnegan, David U. Himmelstein, Sharon Touw, and Steffie Woolhandler. 2019. “Implications of Changing Public Charge Immigration Rules for Children Who Need Medical Care.” JAMA Pediatrics, July, e191744. https://doi.org/10.1001/jamapediatrics.2019.1744.

Immigration enforcement: health consequences

Artiga, Samantha, and Barbara Lyons. 2018. “Family Consequences of Detention/Deportation: Effects on Finances, Health, and Well-Being.” Kaiser Family Foundation. https://www.kff.org/disparities-policy/issue-brief/family-consequences-of-detention-deportation-effects-on-finances-health-and-well-being/.

McKenzie, Katherine C. 2019. “Loud, Gray, and Arbitrary — The Compounding Trauma of Detention for Asylum Seekers.” New England Journal of Medicine 380 (9): 807–9. https://doi.org/10.1056/NEJMp1816400.

Spiegel, Paul, Nancy Kass, and Leonard Rubenstein. 2019. “Can Physicians Work in US Immigration Detention Facilities While Upholding Their Hippocratic Oath?” JAMA, August. https://doi.org/10.1001/jama.2019.12567.

Stoughton, Sarah, and Kathryn Hampton. 2019. “Not in My Exam Room: How U.S. Immigration Enforcement Is Obstructing Medical Care.” Physicians for Human Rights. https://phr.org/our-work/resources/not-in-my-exam-room/.

Migration and metropolitan areas in the United States

Kalor, Yair, Mel Meder, Satya Rhodes-Conway, and Mariah Young-Jones. 2018. “Building Immigrant-friendly Cities.” Mayors Innovation Project. https://mayorsinnovation.org/publications/Building-Immigrant-Friendly-Cities-a-Guide-for-City-leaders/.

Passel, Jeffrey S., and D’Vera Cohn. 2019. “Twenty Metro Areas Are Home to Six-in-Ten Unauthorized Immigrants in U.S.” Pew Research Center. https://www.pewresearch.org/fact-tank/2019/03/11/us-metro-areas-unauthorized-immigrants/.

For more resources, visit The Hastings Center’s Undocumented Patients public database.

Ben Wills is a project manager and research assistant at The Hastings Center. Nancy Berlinger is a research scholar at The Hastings Center and the cofounder of the Center’s Undocumented Patients project.